Reformulation of food and beverages changes the ingredients to produce a more healthful product. Reformulation is a strategy to reduce exposure to added sugars, with the goal of reducing the amount in a given product while not causing the product to become less healthful with respect to total calories and other nutrients. It can be achieved either as a voluntary effort on the part of food and beverage producers, or as a result of government regulation. Either way, producers would work toward meeting a maximum sugar content for a specific product and/or an average content across a product category. Then industry food scientists would look for other ingredients to substitute for the sugar while maintaining product taste, mouth feel, bulk, shelf life, and other attributes.1
The sugar content of a given type of food or beverage varies widely—across brands or even within a given brand across countries. For example, a can of Dr. Pepper sold in the United States has 40 grams of sugar, while the same amount in Thailand has only 22 grams. As part of its commitment to the Partnership for a Healthier America, the Dannon Company has pledged that by 2017, 100 percent of its children’s products will have less than 23 grams of sugar, up from 30 percent in 2014. These examples show that it is possible to reformulate.
Reformulation has the potential to improve diet quality without requiring consumers to make a conscious choice to actively avoid added sugars,2 which are present in 68 percent of all processed foods. It takes a lot of effort to cut down on sugar if we have to know how much sugar is in a product, figure out what proportion of the daily maximum intake this represents, and keep track of the sugar consumed across all food sources eaten that day. Reformulating products with less added sugar makes reducing intake effortless for consumers.
And reformulation can save lives. A French study estimated that deaths from nutrition-related diseases could be reduced by 5 percent—thousands of lives per year—with much greater benefits among low-income people.3
What does it take for the food and beverage industry to reformulate?
The food and beverage industry needs incentives to reformulate. The incentives can come from consumer demand for healthier, lower-sugar products or through government action.
More and more people are becoming aware of the negative health effects of consuming too much added sugar. They are seeking out lower-sugar products. Public education campaigns can increase demand for lower-sugar products. Placing information about sugar content on products gives consumers the information they can use to choose lower-sugar products and encourages manufacturers to reduce sugar so their products appear more healthful. New federal rules will require the nutrition facts panel to show the amount of added sugar per serving and the percentage of total daily recommended intake this contributes. Placing information on the front of a package in a simple, graphic, color-coded format would make it even easier for consumers see how much sugar is in the product they are thinking about purchasing.
Government can establish a framework to encourage the food and beverage industry to voluntarily reduce the sugar content of foods and beverages and require it to do so if the voluntary approach fails to meet sugar reduction targets.
Government can implement a stepped approach to secure industry compliance. Experience with reducing salt in the food supply suggests that progress on sugar could be made with a similar framework:4
- Establish the foundation
- Set a national target for reducing sugar across the population.
- Collect baseline sugar consumption data and establish a system for regular periodic monitoring of consumption.
- Develop and maintain a database of the sugar content of food and beverage categories and sub-categories.
- Set measurable targets for each food manufacturer and retailer for meeting its share of national targets.
- Set reformulation targets for categories and subcategories, including caps on maximum sugar content. Engage companies—especially those whose products contribute the most sugar to the food supply—in voluntary efforts to reformulate. Require participating companies to publicly report on actions they are taking to meet targets and progress in meeting sugar targets. If this step does not lead to attainment of goals and targets, move to the next step.
- Set voluntary average sugar reduction targets for each manufacturer’s portfolio as well as maximum sugar caps for categories and subcategories. While compliance is voluntary, high-sugar labels are required on products exceeding caps. Require annual action and sugar content reports.
- Set mandatory targets if companies fail to make adequate progress in meeting voluntary targets.
To ensure accountability for progress, government should establish incentives and sanctions, including those affecting organizational reputation; make sure voluntary agreements are public and visible; and monitor and report participating companies’ progress toward agreed-upon goals.5
Examples of voluntary reformulation efforts
Tesco in the United Kingdom pledges to reduce sugar content of sodas by 5% a year
Tesco is one of the largest food retailers in the world. In 2014, the chain agreed to an incremental, unobtrusive reformulation strategy on soft drinks that includes:
- Removing all added sugar from the “Kids” category (both name-brand and house-brand products)
- Reformulating its house-brand, full-sugar products to reduce sugar content by 5% every year ongoing
- Begin removing all added sugars from mainstream fruit juice concentrate products
- Focusing on water, fruit juice, and flavored water to promote healthier lives
Partnership for a Healthier America
Partnership for a Healthier America encourages companies to make commitments to improve their nutritional offerings, including reducing sugar. For example, The Dannon Company pledged to reduce the amount of total sugar to 23 grams or less per 6-oz. serving in 100 percent of products for children and in 70 percent of the company's products overall by the end of the three-year period. By the end of the second year of its commitment, Dannon reported in May, 2016 that 76 percent all products. For children's products, 93 percent of children’s products met the sugar target, up from the starting point of 29.2 percent. Learn more by visiting their web site. 6
The nutritional impact of making this change could depend on what share of the 23 grams is added versus naturally occurring sugar, such as the lactose in dairy foods. Nutrition labeling rules do not yet require listing added sugars separately. It is worth noting that 6 oz. of Dannon All Natural Plain Lowfat Yogurt has 12 grams of sugar, presumably from lactose rather than added sugar.
Voluntary sugar reduction in France
France has a government-led, voluntary program for sugar reduction. The food and beverage industry has committed to reformulate food products to reduce sugar through charters of voluntary commitment. The charters have resulted in product reformulations leading to a significant reduction in sugar in some food categories. For breakfast cereals, for example, manufacturers between 2001 and 2008 reduced sugar in breakfast cereals by 10 percent, with a quarter of cereals sold reducing sugar by 1.5 grams to 9 grams per 100 grams. Based on the first 15 signed charters of commitment, up to 13,000 tons of sugar were removed from the French food market over the period of two years (2008–2010). This suggests consumer acceptance has been maintained. 7
Reformulation works: The salt and trans fats examples
Reducing salt through reformulation
Salt levels in foods have gone down in 19 countries with reformulation strategies and 12 countries have reported declines in salt intake in their populations. 8
United Kingdom Salt Reduction Initiative
The United Kingdom salt reduction initiative sets incremental targets for salt content for each food group using maximum and average or sales-weighted average targets to be attained in a specified time frame.9 Since its launch in 2004, there has been a gradual, progressive reduction in salt content of food and salt consumption.10 The National Institute for Health and Care Excellence estimated that this prevented around 18,000 strokes and heart attacks, and saved around £1.5 billion in health care costs per year in the United Kingdom. The U.K. population has adjusted to the taste of lower salt foods. There has been no loss of sales or switching between products as a result of salt reduction, or addition of salt at the table. 11
In the U.S., the New York City Health Department is coordinating a similar public-private partnership. The National Salt Reduction Initiative sets voluntary targets for salt levels in 62 categories of packaged food and 25 categories of restaurants.
Artificial trans fats
Artificial trans fats used to be a common ingredient in many processed foods and restaurant menu items. As evidence mounted that it caused heart disease, public health advocates pushed for labeling the amount of artificial trans fat in products, for elimination of artificial trans fats from restaurant food, and ultimately for removal of artificial trans fats from all foods. While the food and beverage industry initially raised the alarm that it would be technically difficult to find a suitable substitute for artificial trans fats, in fact it has been quite feasible to do so. A recent systematic review of the evidence of the impact of artificial trans fats regulations concluded that “maximum limits and mandated labeling can lead to reductions in [in trans fats] and appear to encourage food producers to reformulate their products.” 12
The Center for Science in the Public Interest has created a timeline from the early 1990s, when concerns over trans fats began to grow, until 2015, when the U.S. Food and Drug Administration banned them in most foods.
Chain restaurants add healthier menu options in response to laws requiring menus to list calories
Beginning in 2008, several U.S. cities implemented laws requiring chain restaurants to post the caloric content of items on their menus. This forced the disclosure of some surprisingly high calorie counts and appears to have led some restaurants to reformulate their offerings in lower calorie versions. 13
1 Lê KA, Robin F, Roger O. Sugar replacers: from technological challenges to consequences on health. Curr Opin Clin Nutr Metab Care. 2016 Jul;19(4):310-5.
2 Combris P, Goglia R, Henini M, Soler LG, Spiteri M. Improvement of the nutritional quality of foods as a public health tool. Public Health. 2011 Oct;125(10):717-24.
3 Leroy P, Réquillart V, Soler LG, Enderli G. An assessment of the potential health impacts of food reformulation. Eur J Clin Nutr. 2016 Jun;70(6):694-9.
4 Magnusson R, Reeve B. Food Reformulation, Responsive Regulation, and "Regulatory Scaffolding": Strengthening Performance of Salt Reduction Programs in Australia and the United Kingdom. Nutrients. 2015 Jun 30;7(7):5281-308.
5 Durand MA, Petticrew M, Goulding L, Eastmure E, Knai C, Mays N. An evaluation of the Public Health Responsibility Deal: Informants' experiences and views of the development, implementation and achievements of a pledge-based, public-private partnership to improve population health in England. Health Policy. 2015 Nov;119(11):1506-14.
6 Partnership for a Healthier America. 2015 Annual Report. P 86. Accessed 6/29/16.
7 Combris P. Interventions publiques et démarches d’entreprises pour l’amélioration de la qualité nutritionnelle de l’offre alimentaire : apports et limites (Requested citation from author – not in PubMed – need to get. Article in Cahiers de Nutrition et de Diététique 49(1) · February 2014. DOI: 10.1016/j.cnd.2013.12.001
8 Trieu K, Neal B, Hawkes C, Dunford E, Campbell N, Rodriguez-Fernandez R, Legetic B, McLaren L, Barberio A, Webster J. Salt reduction initiatives around the world: a systematic review of progress towards the global target. PloS One. 2015 Jul 22;10(7):e0130247.
9 Food.gov.uk - Salt Timeline web page.
10 Eyles H, Webster J, Jebb S, Capelin C, Neal B, Ni Mhurchu C. Impact of the UK voluntary sodium reduction targets on the sodium content of processed foods from 2006 to 2011: analysis of household consumer panel data. Prev Med. 2013 Nov;57(5):555-60.
11 He FJ, Brinsden HC, Macgregor GA. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens 2014;28:345–52.
12 Hendry VL, Almíron-Roig E, Monsivais P, Jebb SA, Benjamin Neelon SE, Griffin SJ, Ogilvie DB. Impact of regulatory interventions to reduce intake of artificial trans-fatty acids: a systematic review. American Journal of Public Health. 2015 Mar;105(3):e32–42.
13 Bruemmer B, Krieger J, Saelens BE, Chan N. Energy, saturated fat, and sodium were lower in entrées at chain restaurants at 18 months compared with 6 months following the implementation of mandatory menu labeling regulation in King County, Washington. J Acad Nutr Diet. 2012 Aug;112(8):1169-76.